Abstract: FR-PO1149
Association Between High-Sensitivity C-Reactive Protein Levels and Cardiovascular Event Rates in US vs. Korean Patients with CKD: A Comparative Analysis of CRIC and KNOW-CKD Cohorts
Session Information
- CKD: Screening, Diagnosis, Serum and Urine Biomarkers, and Scoring Indices
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Ko, Ye Eun, Department of Internal Medicine, Yonsei University College of Medicine, Institute of Kidney Disease Research, Seoul, Korea (the Republic of)
- Ko, Byounghwi, Department of Internal Medicine, Yonsei University College of Medicine, Institute of Kidney Disease Research, Seoul, Korea (the Republic of)
- Park, Cheol Ho, Department of Internal Medicine, Yonsei University College of Medicine, Institute of Kidney Disease Research, Seoul, Korea (the Republic of)
- Koh, Hee Byung, Department of Internal Medicine, Yonsei University College of Medicine, Institute of Kidney Disease Research, Seoul, Korea (the Republic of)
- Kim, Hyung Woo, Department of Internal Medicine, Yonsei University College of Medicine, Institute of Kidney Disease Research, Seoul, Korea (the Republic of)
- Park, Jung Tak, Department of Internal Medicine, Yonsei University College of Medicine, Institute of Kidney Disease Research, Seoul, Korea (the Republic of)
- Yoo, Tae-Hyun, Department of Internal Medicine, Yonsei University College of Medicine, Institute of Kidney Disease Research, Seoul, Korea (the Republic of)
- Kang, Shin-Wook, Department of Internal Medicine, Yonsei University College of Medicine, Institute of Kidney Disease Research, Seoul, Korea (the Republic of)
- Oh, Kook-Hwan, Seoul National University Hospital Department of Internal Medicine, Seoul, Korea (the Republic of)
- Anderson, Amanda Hyre, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, United States
- Yang, Wei, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- Cohen, Jordana B., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- Rahman, Mahboob, Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
- Han, Seung Hyeok, Department of Internal Medicine, Yonsei University College of Medicine, Institute of Kidney Disease Research, Seoul, Korea (the Republic of)
Background
Chronic kidney disease (CKD) patients have higher cardiovascular disease burden than the general population. U.S. CKD patients show higher cardiovascular events than Korean patients, but mechanisms remain unclear. This study investigated whether systemic inflammation differences contribute to this disparity between cohorts.
Methods
5,614 patients from two cohorts were analyzed: 3,601 from the Chronic Renal Insufficiency Cohort (CRIC) and 2,013 from the KoreaN Cohort Study for Outcomes in Patients With CKD (KNOW-CKD). Patients were categorized by baseline high sensitive C-reactive protein (hsCRP) into three inflammatory groups: low (<1.0 mg/L), moderate (1.0-2.99 mg/L), and high (≥3.0 mg/L). Primary outcome was major adverse cardiovascular events (MACE). To assess factors contributing to between-cohort MACE differences, we applied Blinder–Oaxaca decomposition analysis, which partitions outcome disparities into: (1) endowment effects, reflecting differences in baseline characteristics, and (2) coefficient effects, capturing differences in how these characteristics relate to outcomes.
Results
The mean age was 56.8±11.3 years, 57.2% male, with median follow-up of 6.0 years (IQR 3.1–10.8). hsCRP distributions differed between cohorts (P<0.001): low hsCRP was more common in Koreans (61.2% vs 23.9%), while high levels were more frequent in U.S. patients (45.3% vs 13.6%). MACE incidence increased with higher hsCRP in both cohorts. U.S. patients had higher event rates across all categories (all P<0.001): 31.6 vs 13.8, 37.9 vs 14.6, and 48.7 vs 15.5 per 1,000 person-years for low, moderate, and high hsCRP. The between-cohort difference in MACE incidence (β=−0.299) was attributable to endowment (β=−0.103, P<0.001) and coefficient (β=−0.293, P<0.001) effects. For log-hsCRP, differences in distribution (β=−0.024, P=0.01) and effect size (β=−0.021, P=0.03) were significant.
Conclusion
Elevated hsCRP levels were associated with higher cardiovascular event rates in both cohorts. The comparable hsCRP–MACE association across cohorts, with higher prevalence of elevated hsCRP in CRIC, may partly explain the greater cardiovascular burden among U.S. CKD patients.
Funding
- NIDDK Support